Why Are We Failing on Diabetes Health Risks?

The numbers are stark. More than 80 percent of Americans with diabetes are not meeting clinical targets to reduce heart disease risk. For people with both diabetes and obesity, more than 90 percent are bearing unnecessary risk. These numbers come from a new scientific statement in Circulation from the American Heart Association. On top of those numbers is the magnitude of global diabetes – 537 million people worldwide. It is a global pandemic “spiraling out of control,” says Professor Andrew Boulton, president of the the International Diabetes Federation. Clearly, we are failing on diabetes health risks.

As to the question of why, the answer lies, at least in part, with how poorly health systems and policy makers are dealing with obesity.

The Failure of Diabetes Prevention

Abundant research tells us how to prevent diabetes and manage its risks. The U.S. Preventive Services Task Force (USPSTF) has straightforward, evidence-based guidelines for prediabetes screening. But a recent study shows that vanishingly few patients actually get that screening. AMA reports that this is one of the biggest missed opportunities in medicine:

“It all points to a disconnect between the philosophy of the profession and the structure of the health care system. On the one hand, the mission of medicine is to keep people healthy, to prevent suffering. But in the current payment system, prevention just isn’t the top priority.

“The U.S. healthcare system for the most part only encourages quality care once people are diagnosed with type 2 diabetes.”

Obesity Treatment Prevents and Controls Diabetes

Decades ago, the Diabetes Prevention Program proved that behavioral support for weight management prevents diabetes. It’s a key element of USPSTF guidance. But health systems, including Medicare, are structured to give little more than lip service. CMS has consistently dragged its feet on efforts for diabetes.

A new paper in JAMA Surgery tells us that gastric bypass enables three quarters of patients to discontinue their diabetes medications after surgery. After five years, most of them (70 percent) still have no needs for those meds. In fact, bariatric surgery is the most effective way by far to put diabetes into remission for people with both diabetes and obesity.

Yet health systems throw up endless barriers to accessing effective obesity care. So the failure on diabetes health risks should be no surprise. This is a classic case of neglecting a slow burning fire until it becomes an overwhelming catastrophe. We’re smarter than this.

Our health systems need to wise up.

Click here for the new scientific statement from AHA and here for further reporting on it. For perspective on dealing with the global threat of diabetes and obesity, click here. Click here for the study of diabetes prevention in U.S. healthcare and here for the study of the reduced need for diabetes meds after bariatric surgery.

The Fallen Jockey, painting by Edgar Degas / WikiArt

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January 13, 2022